EP0207884A2 - Straight self-tensioning bone plate - Google Patents
Straight self-tensioning bone plate Download PDFInfo
- Publication number
- EP0207884A2 EP0207884A2 EP86730103A EP86730103A EP0207884A2 EP 0207884 A2 EP0207884 A2 EP 0207884A2 EP 86730103 A EP86730103 A EP 86730103A EP 86730103 A EP86730103 A EP 86730103A EP 0207884 A2 EP0207884 A2 EP 0207884A2
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- European Patent Office
- Prior art keywords
- holes
- plate
- fracture
- bone plate
- bone
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- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
- A61B17/8014—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones the extension or compression force being caused by interaction of the plate hole and the screws
Definitions
- the invention relates to a bone plate of the type specified in the preamble of claim 1.
- Such self-tensioning pressure plates have pressure holes which - seen in the longitudinal direction - have slanted slideways towards the center of the plate, so that a screw which is inserted into such a hole has a tendency to tighten towards the center of the plate with increasing tightening move. Since the screw is screwed into a bone adjacent to a fracture to be fixed, it is moved in the direction of the imaginary central axis of the plate, so that the fracture is closed in this way.
- the "central axis" of the plate forms the line that separates areas of the plate from one another in which the pressure holes have differently inclined slideways. This central axis is to be attached in the area of the fracture, so that the sliding directions of the pressure holes on both sides of this fracture are directed so that the fracture elements connected with the screws move in the direction of this imaginary central axis. (If the plate is asymmetrical in design, this "central axis" does not actually need to be exactly in the middle (in relation to the longitudinal axis of the plate).
- the invention specified in claim 1 is based on the object of a plate of the type mentioned form that on the one hand it allows a maximum compression path via its pressure holes, while on the other hand the compression achieved is secured against subsequent displacements, so that an undesired mobility of the plate relative to the bone to be fixed is prevented.
- the invention is based on the knowledge that the subsequent mobility of an exclusively equipped with Drucklöc NEN plate - which up to now has even been regarded as an advantage - is extremely harmful.
- This mobility allows the fracture to be "set” when the broken bone is only under pressure, so that healing can only take place without hindrance if no other forces are exerted on the fracture apart from a uniform pressure.
- plate osteosynthesis serves to give the patient back a limited amount of movement as early as possible - taking into account the protection of the fracture - it can be expected that torsional or bending stresses will also occur.
- the plate has only one side of the bone supports and if it is subjected to a bending stress, the fracture area either opens up or tends to close in the sense that only the areas of the fracture located away from the plate are pressed against one another and then possibly under the entering and then possibly under the occurring overload give way, so that the fracture gap widens in this area.
- the two parts of the fracture are re-bent when the plate is bent outside and the use of only pressure holes to migrate to one another, the adjacent plate-near areas of the bone lying on one another only with a small cross-section and possibly yielding when subjected to pressure, so that the fracture parts of the bone slide further.
- the single figure shows an embodiment of the bone plate according to the invention in a perspective top view.
- the plate shown in the figure is a straight bone plate which has a certain curvature has in the transverse direction, so that it nestles against long bones in the longitudinal direction.
- six holes 2 to 7 are arranged one behind the other, the holes 2, 4, 5 and 7 being designed as pressure holes which have bevels which, when screwing in bone screws, cause the screw to move in the direction of the axis of symmetry 8 of the plate.
- the screws 3 and 6 are designed as round holes, ie when screwing in and tightening bone screws through these bores, no displacement of the screw and plate relative to one another is produced. On the contrary, a connection which is not displaceable in the longitudinal direction is brought about.
- the round holes are arranged so that at least one pressure hole of each sliding direction is present between these round holes, i.e. the round holes are at least one pressure hole away from the intended fracture area of the bone to be fixed with the plate are.
- the holes which are closest to the fracture gap - and have pressure holes - are first provided with screws and tightened such that the desired sliding action of the bone and plate relative to one another results, which results in the fracture gap downsized. Subsequent compression of the fracture can then be carried out with the tightening of further screws with respect to the other pressure bores 2 and 7 gap can be reached, the elongated holes 4 and 5 allowing additional mobility of the screw heads to the axis of symmetry 8 beyond the slanted slideway.
- the exemplary embodiment according to the invention merely represents a possible implementation of the invention.
- the round bores 3 and 6 can preferably also be arranged as the last bore in the row of holes, so that several fracture gaps (in the event of multiple fractures) can also be closed via the pressure holes between them.
- the arrangement of the holes can also be chosen asymmetrically in accordance with the requirements to be met.
Abstract
Description
Die Erfindung betrifft eine Knochenplatte der im Oberbegriff des Anspruchs 1 angegebenen Art.The invention relates to a bone plate of the type specified in the preamble of claim 1.
Selbstspannende gerade Knochenplatten sind beispielsweise aus dem Aufsatz von Bagby in "The Journal of Bone and Joint Surgery", Nr. 5, Juli 1977, Seiten 625 bis 629 bekannt.Self-tightening straight bone plates are, for example, from Bagby's essay in "The Journal of Bone and Joint Surgery ", No. 5, July 1977, pages 625 to 629.
Derartige selbstspannende Druckplatten weisen Drucklöcher auf, die - in Längsrichtung gesehen - zur Mitte der Platte hin abgeschrägte Gleitbahnen aufweisen, so daß eine Schraube, die in ein derartiges Loch eingeführt wird, mit zunehmendem Anziehen die Tendenz hat, sich auf der Gleitbahn zur Plattenmitte hin zu bewegen. Da die Schraube benachbart zu einer zu fixierenden Fraktur in einen Knochen ein geschraubt wird, wird dieser mit in Richtung der gedachten Mittelachse der Platte bewegt, so daß die Fraktur auf diese Weise geschlossen wird.Such self-tensioning pressure plates have pressure holes which - seen in the longitudinal direction - have slanted slideways towards the center of the plate, so that a screw which is inserted into such a hole has a tendency to tighten towards the center of the plate with increasing tightening move. Since the screw is screwed into a bone adjacent to a fracture to be fixed, it is moved in the direction of the imaginary central axis of the plate, so that the fracture is closed in this way.
Die "Mittelachse" der Platte bildet dabei diejenige Linie, welche Bereiche der Platte voneinander trennt, in denen die Drucklöcher unterschiedlich geneigte Gleitbahnen aufweisen. Diese Mittelachse ist im Bereich der Fraktur anzubringen, so daß die Gleitrichtungen der Drucklöcher beidseitig dieser Fraktur so gerichtet sind, daß sich die mit den Schrauben verbundenen Frakturelemente in Richtung auf diese gedachte Mittelachse zu bewegen. (Bei unsymmetrischer Gestaltung der Platte braucht sich diese "Mittelachse" sich also nicht tatsächlich (bezogen auf die Längsachse der Platte) genau in der Mitte zu befinden.The "central axis" of the plate forms the line that separates areas of the plate from one another in which the pressure holes have differently inclined slideways. This central axis is to be attached in the area of the fracture, so that the sliding directions of the pressure holes on both sides of this fracture are directed so that the fracture elements connected with the screws move in the direction of this imaginary central axis. (If the plate is asymmetrical in design, this "central axis" does not actually need to be exactly in the middle (in relation to the longitudinal axis of the plate).
Es ist bekannt, bei derartigen Druckplatten neben mit Gleitbahnen versehenen Drucklöchern auch Rundlöcher anzubringen. Die Anordnung der Rundlöcher erfolgte dabei aber stets so, daß auf der einen Seite der Mittellinie ausschließlich Rundlöcher vorgesehen waren, während Drucklö cher nur auf der anderen Seite angeordnet sind (vergleiche den vorstehend genannten Aufsatz). Diese Anordnung bezweckte, das Vorgehen beim Befestigen von geraden Platten und Winkelplatten in Übereinstimmung zu bringen. Da auf derjenigen Seite, auf denen die Rundlöcher vorgesehen sind, kein Gleitvorgang stattfinden kann, ist der Kompressionsweg für die Fraktur verringert. Weil über jedes der Drucklöcher lediglich ein Kompressionsweg von rund einem Millimeter maximal erreicht werden kann, bedeutet dieser Verzicht einen Nachteil, da die Anwendbarkeit der Platte zunimmt, wenn der Kompressionsweg größer ist.It is known to provide round holes in such printing plates in addition to pressure holes provided with slideways. The arrangement of the round holes was always such that only round holes were provided on one side of the center line, while pressure release are only arranged on the other side (compare the article mentioned above). The aim of this arrangement was to bring together the procedure for fastening straight plates and angle plates. Since no sliding process can take place on the side on which the round holes are provided, the compression path for the fracture is reduced. Because only a maximum compression path of around one millimeter can be achieved via each of the pressure holes, this waiver means a disadvantage, since the applicability of the plate increases as the compression path increases.
Andererseits besteht bei denjenigen Platten, welche ausschließlich Drucklöcher aufweisen, der Nachteil, daß bei Resorption von Knochenmaterial im Bereich der Fraktur die Fixtionswirkung einer derartigen Platte nachläßt, weil die Kompressionswirkung ausschließlich in Richtung auf die Fraktur besteht - also nur eine Auseinanderbewegung der Frakturteile parallel zur Plattenrichtung bezogen auf die Ausgangssitution gesperrt ist. Eine Platte, welche nicht in der Lage ist, die Konstanz im Fixationsbereich aufrechtzuerhalten, stellt aber eine Gefahr dar, weil Mikrobewegungen das Verheilen der Fraktur verhindern können. Ziel einer derartigen Plattenosteosynthese ist es ja gerade, die Fraktur so ruhig zu stellen, daß beschleunigt ein Gefäßaufbau und Verheilen stattfinden kann. Bewegungen im Mikrobereich sind dabei äußerst schädlich und können den Heilungsverlauf durch Erzeugung von Pseudarthrosen im schlechtesten Fall vollständig unterbinden.On the other hand, there is the disadvantage of those plates that only have pressure holes that the resorption effect of such a plate diminishes when bone material is resorbed in the area of the fracture, because the compression effect only exists in the direction of the fracture - that is, only a movement of the fracture parts parallel to the plate direction is locked based on the initial situation. A plate that is unable to maintain consistency in the fixation area is a danger because micro-movements can prevent the fracture from healing. The aim of such a plate osteosynthesis is to immobilize the fracture so that vessel building and healing can accelerate. Movements in the micro range are extremely damaging and can, in the worst case, completely prevent the course of healing by generating pseudarthroses.
Der im Anspruch 1 angegebenen Erfindung liegt die Aufgabe zugrunde, eine Platte der eingangs genannten Gattung so auszubilden, daß sie einerseits über ihre Drucklöcher einen maximalen Kompressionsweg zuläßt, während andererseits die erreichte Kompression gegen nachträgliche Verschiebungen gesichert ist, so daß eine unerwünschte Beweglichkeit der Platte gegenüber dem zu fixierenden Knochen verhindert ist.The invention specified in claim 1 is based on the object of a plate of the type mentioned form that on the one hand it allows a maximum compression path via its pressure holes, while on the other hand the compression achieved is secured against subsequent displacements, so that an undesired mobility of the plate relative to the bone to be fixed is prevented.
Die Erfindung beruht auf der Erkenntnis, daß die nachträgliche Beweglichkeit einer ausschließlich mit Drucklöc ern ausgestatteten Platte - welche bisher sogar gelegentlich als Vorteil angesehen wurde - äußerst schädlich ist. Zwar gestattet diese Beweglichkeit ein "Setzen" der Fraktur, wenn der gebrochene Knochen ausschließlich unter Druckbelastung steht, so daß ein Verheilen nur dann unbehindert stattfinden kannt, wenn außer einem gleichmäßigen Druck keine weiteren Kräfte auf die Fraktur ausgeüb werden. Da die Plattenosteosynthese aber dazu dient, den Patienten möglichst frühzeitig eine - unter Berücksichtigung der Schonung der Fraktur - eingeschränkte Bewegungsmöglichkeit zurückzugeben, ist damit zu rechnen, daß auch Torsions- oder Biegebeanspruchungen auftreten. Dabei spielt eine besondere Rolle, daß die Platte den Knochen nur einseitigtützt und wenn sie einer Biegebeanspruchung ausgesetzt ist der Frakturbereich entweder aufklafft oder die Tendenz hat sich in dem Sinn zu schließen, daß nur die von der Platte entfernt gelegenen Bereiche der Fraktur aufeinandergepreßt werden und dann möglicherweise unter der eintretenden werden und dann möglicherweise unter der eintretenden Überlastung nachgeben, so daß sich der Frakturspalt in diesem Bereich zusätzlich erweitert.The invention is based on the knowledge that the subsequent mobility of an exclusively equipped with Drucklöc NEN plate - which up to now has even been regarded as an advantage - is extremely harmful. This mobility allows the fracture to be "set" when the broken bone is only under pressure, so that healing can only take place without hindrance if no other forces are exerted on the fracture apart from a uniform pressure. However, since plate osteosynthesis serves to give the patient back a limited amount of movement as early as possible - taking into account the protection of the fracture - it can be expected that torsional or bending stresses will also occur. It plays a special role that the plate has only one side of the bone supports and if it is subjected to a bending stress, the fracture area either opens up or tends to close in the sense that only the areas of the fracture located away from the plate are pressed against one another and then possibly under the entering and then possibly under the occurring overload give way, so that the fracture gap widens in this area.
Bei einer entsprechenden Wechsellast werden also die beiden Teile der Fraktur bei einer Biegung der Platte nach außen und der Verwendung von ausschließlich Drucklöchern aufeinander zu wandern, wobei die benachbarten plattennahen Bereiche des Knochens nur mit geringem Querschnitt aufeinander liegen und bei einer Druckbelastung gegebenenfalls nachgeben, so daß ein weiteres Nachrutschen der Frakturteile des Knochens die Folge ist.With a corresponding alternating load, the two parts of the fracture are re-bent when the plate is bent outside and the use of only pressure holes to migrate to one another, the adjacent plate-near areas of the bone lying on one another only with a small cross-section and possibly yielding when subjected to pressure, so that the fracture parts of the bone slide further.
Bei einer Biegung der Platte in Gegenrichtung werden die betreffenden Frakturteile dann aber wieder voneinander entfernt, so daß ein Verrutschen der Knochenfragmente bezüglich der Platte in entgegengesetzter Richtung - also wieder zurück - erfolgen wird. Eine derartige Bewegungsfolge setzt sich bei Auftreten der Wechsellast - unter fortwährender Vergrößerung des möglichen Verschiebungswegs - fort , so daß die Fraktur nicht in der notwendigen Weise ruhiggestellt ist.When the plate bends in the opposite direction, the fracture parts in question are then removed from each other again, so that the bone fragments will slip in the opposite direction with respect to the plate - that is, back again. Such a sequence of movements continues when the alternating load occurs - with a continuous increase in the possible displacement path - so that the fracture is not immobilized in the necessary manner.
Durch die erfindungsgemäßen Maßnahmen werden diese Nachteile sicher vermieden.These disadvantages are reliably avoided by the measures according to the invention.
Vorteilhafte Weiterbildungen der Erfindung sind in den Unteransprüchen gekennzeichnet bzw. werden nachstehend zusammen mit der Beschreibung der bevorzugten Ausführung der Erfindung anhand der Zeichnung näher dargestellt.Advantageous developments of the invention are characterized in the subclaims or are shown in more detail below together with the description of the preferred embodiment of the invention with reference to the drawing.
Die einzige Figur zeigt ein Ausführungsbeispiel der erfindungsgemäßen Knochenplatte in perspektivischer Draufsicht.The single figure shows an embodiment of the bone plate according to the invention in a perspective top view.
Bei der in der Figur dargestellten Platte handelt es sich um eine gerade Knochenplatte, welche eine gewisse Wölbung in Querrichtung aufweist, so daß sie sich an lange Röhrenknochen in Längsrichtung anschmiegt. In Längsrichtung der Platte sind sechs Löcher 2 bis 7 hintereinander angeordnet, wobei die Löcher 2, 4, 5 und 7 als Drucklöcher ausgebildet sind, welche Abschrägungen aufweisen, die beim Eindrehen von Knochenschrauben die Schraube in Richtung zur Symmetrieachse 8 der Platte hin wandern lassen. Die Schrauben 3 und 6 sind als Rundlöcher ausgebildet, d.h. beim Einschrauben und Festziehen von Knochenscrauben durch diese Bohrungen hindurch wird keine Verschiebung von Schraube und Platte relativ zueinander erzeugt. Es wird im Gegenteil eine in Längsrichtung nicht verschiebliche Verbindung bewirkt.The plate shown in the figure is a straight bone plate which has a certain curvature has in the transverse direction, so that it nestles against long bones in the longitudinal direction. In the longitudinal direction of the plate, six holes 2 to 7 are arranged one behind the other, the
Es ist ersichtlich, daß bei der erfindungsgemäßen Platte gemäß Ausführungsbeispiel die runden Bohrungen so angeordnet sind, daß zwischen diesen runden Bohrungen mindestens eine Druckbohrung jeder Gleitrichtung vorhanden ist, die Rundbohrungen also mindestens um eine Druckbohrung vom vorgesehenen Frakturbereich des mit der Platte zu fixierenden Knochens enfernt gelegen sind.It can be seen that in the plate according to the invention the round holes are arranged so that at least one pressure hole of each sliding direction is present between these round holes, i.e. the round holes are at least one pressure hole away from the intended fracture area of the bone to be fixed with the plate are.
Zur Fixierung des Knochens mit der erfindungsgemäßen Druckplatte werden zunächst die Bohrungen, welche dem Frakturspalt am nächsten gelegen sind - und Drucklöcher aufweisen -, mit Schrauben versehen und diese so festgezogen, daß sich die angestrebte Gleitwirkung von Knochen und Platte relativ zueinander ergibt, welche den Frakturspalt verkleinert. Anschließend kann mit dem Festziehen von weiteren Schrauben bezüglich der anderen Druckbohrungen 2 und 7 eine weitergehende Kompression des Fraktur spaltes erreicht werden, wobei die Langlöcher 4 und 5 eine zusätzliche Beweglichkeit der Schraubenköpfe zu Symmetrieachse 8 hin über die abgeschrägte Gleitbahn hinaus zulassen.To fix the bone with the pressure plate according to the invention, the holes which are closest to the fracture gap - and have pressure holes - are first provided with screws and tightened such that the desired sliding action of the bone and plate relative to one another results, which results in the fracture gap downsized. Subsequent compression of the fracture can then be carried out with the tightening of further screws with respect to the
Ist der Frakturspalt auf diese Weise möglichst weitgehend geschlossen, werden die Schrauben in die Rundbohrungen 3 und 6 eingebracht, welche ein weiteres Verschieben der Knochensegmente verhindern, so daß insbesondere bei in bezug auf die Platte eintretenden Biegebelastungen keine alternierenden Verschiebebewegungen eintreten können.If the fracture gap is closed as far as possible in this way, the screws are introduced into the
Das erfindungsgemäße Ausführungsbeispiel stellt lediglich eine mögliche Realisierung der Erfindung dar. Die Rundbohrungen 3 und 6 können bevorzugt auch als letzte Bohrung in der Reihe der Löcher angeordnet sein, so daß über die zwischen ihnen liegenden Drucklöcher auch mehrere Frakturspalte (bei Mehrfachbrüchen) geschlossen werden können. Entsprechend den zu erfüllenden Forderungen kann die Anordnung der Löcher auch unsymmetrisch gewählt werden.The exemplary embodiment according to the invention merely represents a possible implementation of the invention. The
Claims (5)
dadurch gekennzeichnet,
daß jeweils ein Rundloch (3, 6) näher zum Ende der Platte (1) hin angeordnet ist als die beiden innersten Drucklöcher (4, 5) unterschiedlicher Gleitrichtung.1. Self-tightening straight bone plate, which contains not only pressure holes but also round holes,
characterized,
that a round hole (3, 6) is arranged closer to the end of the plate (1) than the two innermost pressure holes (4, 5) of different sliding directions.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
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DE19858519854 DE8519854U1 (en) | 1985-07-05 | 1985-07-05 | Self-tightening straight bone plate |
DE8519854U | 1985-07-05 |
Publications (2)
Publication Number | Publication Date |
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EP0207884A2 true EP0207884A2 (en) | 1987-01-07 |
EP0207884A3 EP0207884A3 (en) | 1987-12-23 |
Family
ID=6782964
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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EP86730103A Withdrawn EP0207884A3 (en) | 1985-07-05 | 1986-07-04 | Straight self-tensioning bone plate |
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EP (1) | EP0207884A3 (en) |
DE (1) | DE8519854U1 (en) |
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US4955886A (en) * | 1988-04-01 | 1990-09-11 | The Trustees Of Columbia University In The City Of New York | Dual-taper, asymmetric hole placement in reconstruction and fracture plates |
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US3528085A (en) * | 1968-03-22 | 1970-09-08 | Walker Reynolds Jr | Bone compression plate |
CH566767A5 (en) * | 1973-06-05 | 1975-09-30 | Synthes Ag | Jawbone fracture compression plate - screw holes elongated in directions at right angles to each other |
CH611147A5 (en) * | 1977-01-07 | 1979-05-31 | Mueller Kurt | Osteosynthesis compression plate |
-
1985
- 1985-07-05 DE DE19858519854 patent/DE8519854U1/en not_active Expired
-
1986
- 1986-07-04 EP EP86730103A patent/EP0207884A3/en not_active Withdrawn
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FR1505513A (en) * | 1966-11-02 | 1967-12-15 | Benoist & Girard Reunis | Osteosynthesis plate |
US3528085A (en) * | 1968-03-22 | 1970-09-08 | Walker Reynolds Jr | Bone compression plate |
CH566767A5 (en) * | 1973-06-05 | 1975-09-30 | Synthes Ag | Jawbone fracture compression plate - screw holes elongated in directions at right angles to each other |
CH611147A5 (en) * | 1977-01-07 | 1979-05-31 | Mueller Kurt | Osteosynthesis compression plate |
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Title |
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MEDIZINISCH-ORTHOP[DISCHE TECHNIK, Februar 1974, Seiten 43-46, Stuttgart; G. BIEHL "Historische Entwicklung der Plattenosteosynthese" * |
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Also Published As
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EP0207884A3 (en) | 1987-12-23 |
DE8519854U1 (en) | 1986-04-30 |
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